Provider Demographics
NPI:1528429065
Name:BALAVITCH, STEPHANI LOU (MSW)
Entity type:Individual
Prefix:
First Name:STEPHANI
Middle Name:LOU
Last Name:BALAVITCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STEPHANI
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7646 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MI
Mailing Address - Zip Code:49338-9611
Mailing Address - Country:US
Mailing Address - Phone:231-349-1859
Mailing Address - Fax:
Practice Address - Street 1:7646 E 13 MILE RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MI
Practice Address - Zip Code:49338-9611
Practice Address - Country:US
Practice Address - Phone:231-349-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI24304131038104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker